Healthcare Provider Details

I. General information

NPI: 1851872741
Provider Name (Legal Business Name): KIYOMI KIMBLE CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2018
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1564 N DAMEN AVE STE 207
CHICAGO IL
60622-2102
US

IV. Provider business mailing address

921 E 54TH PL
CHICAGO IL
60615-5011
US

V. Phone/Fax

Practice location:
  • Phone: 872-253-4891
  • Fax: 872-241-0328
Mailing address:
  • Phone: 773-510-1794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: